9
• 2008: “HORIZONS-AMI” study Resulted in a nationwide
increase in bivalirudin use for all PCI
• 2008 – 2014:
• Transradial PCI becomes more widespread reducing bleeding risk
• Sporadic cases of stent thrombosis with bivalirudin reported in the literature
• 2014: “HEAT-PPCI” study challenged the use of bivalirudin
• Suggested that a heparin strategy reduced the incidence of major adverse
ischaemic events with no increase in bleeding complications
• Showed bivalirudin was about 300 times more expensive than heparin. It was
estimated that switching to heparin would reduce the cost of their annual 1000
PPCI cases by £500 000, ~ $640,000 (US dollars)
• Despite the new information from the “HEAT-PPCI” study and our own
cost data, many physicians were reluctant to stop using the bivalirudin.
Best practices changed with new studies
Sources : [2] NEJM. Bivalirudin during Primary PCI in Acute Myocardial Infarction (2008)
[3] American College of Cardiology. How Effective are Antithrombotic Therapies in Primary PCI – HEAT PCI (2014)